TB in Mumbai prisons a steadily growing crisis

Poor diet, low immunity, overcrowding, mingling of those being treated for TB with other prisoners lead to a vicious cycle

Data from the Revised National Tuberculosis Control Programme (RNTCP) shows that TB prevalence in India is 1.67 per 1,000 people. In Mumbai’s Arthur Road Jail, in 2015, as many as 35 among the 2,400 inmates were treated for TB, which stands at 14 per 1,000.

The other reason for Mohammad’s family to be concerned is that at least two TB deaths were reported from Mumbai’s prisons recently. On November 8 last year, Abdi Chama (28), also arrested for piracy along with Mohammad and kept in Taloja jail, succumbed at JJ Hospital. On October 26, Chotelal Chaudhari (23), an undertrial in Arthur Road Jail, died after two months’ intensive treatment at Sewri TB hospital.

The local DOTS (Directly Observed Treatment, Short-Course) centre that provides free anti-TB medication at Arthur Road Jail was supplying medicines for 24 prisoners in 2013, which rose to 26 in 2014 and 35 in 2015. Currently, nine inmates at Arthur Road Jail and two at Byculla women’s prison are availing DOTS treatment.

The high incidence of TB in these jails, say experts, is due to a poor diet and poor infection control mechanisms once a prisoner is diagnosed with the infection.

A senior pulmonary doctor at JJ Hospital said poor diet leads to lower immunity. “They also live in closed quarters. The disease is air-borne and can spread from one prisoner to another,” he said. Arthur Road Jail has a capacity of 800 but houses over 2,400 undertrials, while Byculla prison with a capacity of 200 and currently houses 210 women and 18 children.

Mohammad, who was in JJ Hospital’s ward 34 until recently, told the resident doctors that he doesn’t like the watery vegetable gravies served in Taloja. A resident doctor from the pulmonary medicine department said he made a note in Mohammad’s report advising jail authorities to ensure a “high-protein diet” before his discharge from hospital last month. “But there is no way of knowing whether these patients are given a better diet once back in jail,” the doctor admitted. “If Mohammad does not eat well, the anti-TB drugs will have little effect.”

In 2015, four prisoners from Taloja jail, three from Arthur Road and one from Byculla women’s prison were admitted at JJ Hospital for treatment of TB.

Jaywant Krishna Patil from Arthur Road jail has been admitted since December 2 to Sewri TB hospital, Asia’s largest such facility for TB treatment. He suffers from MDR-TB. “I did not have TB before I went to jail. It got diagnosed after Diwali last year there,” he complains. His frail frame curled up on a cot in Ward 7, Patil says he ate and spent his day with other prisoners even after his diagnosis, though the bacilli in his cough and sneeze can infect others.

The Maharashtra State Human Rights Commission (MSHRC), having done surprise checks in central prisons last year, is set to submit a report to the state highlighting the issues of over-crowding and poor medical care. “In all jails, we noticed over-crowding. Lack of space to live properly and deprivation of health rights is a violation of human rights,” said MSHRC chairperson Dr S R Bannurmath.

Patients who were healthy before landing in jail are the most bitter. An autorickshaw driver, aged 35, was HIV-positive when he was sent to Arthur Road jail in May 2014 in a murder case, but anti-retroviral treatment (ART) had ensured he was healthy. “He was well-built. Never saw him weak before he went to jail,” a friend says. Diagnosed with TB in jail last year, he was convicted in December and moved to Nashik Central jail. His lawyer, Prakash Salsingikar, says doctors in Nashik have warned that the prisoner is not being brought for treatment regularly. “There were repeated endorsements by doctors to send him for regular treatment. The jail would just send a constable to collect medicines.”

In Byculla prison, 30 to 40 women prisoners share a dormitory, sleep on mattress next to each another. “A TB patient is kept in a separate room at night. But she would eat and roam with us,” said Sonali Shinde, released from Byculla prison last year.

It is an unbreakable loop, for now. TB infection cannot be cured unless a protein-rich diet, comprising eggs or milk, is given to patients. And if infected prisoners mingle closely with others in confined spaces, infection cannot be controlled.

Currently, prisoners are given two chapatis, a bowl of rice, banana, milk, vegetable and dal as per the prescribed government norms, said Arthur Road jail Superintendent B M Bhosale. A single meal costs about Rs 35. For TB or HIV infected patients, as prescribed by the jail medical officer, extra milk is given. Patil, the prisoner admitted in Sewri Hospital, claims he continued to receive the routine meal even after diagnosis.

Maharashtra increased its budget for prisons in 2014-15, to Rs 232.59 crore from the previous Rs 226.56 crore, a marginal hike of 2.7 per cent, significantly less than additional spends budgeted by even Bihar or Rajasthan. A committee headed by Inspector General Bipin Kumar Singh submitted a proposal last year to the state government suggesting that prisoners be categorised and provided meals with varying calories including, for example, an addition of boiled eggs, fruits and milk for post-hospitalisation prisoners. The proposal has not made much progress.

Despite several attempts, Byculla prison superintendent did not comment. Arthur Road’s Superintendent Bhosale said, “We are following all measures prescribed by the government.”

Sana Das of the Commonwealth Human Rights Initiative says higher allocation for health amenities for prisoners is a must. “A disease that can be cured with medicines is spreading among prisoners. Prisoners’ health problems are just not a priority.”

Source: The Indian Express